What are the responsibilities and job description for the Audit Case Disposition Specialist - INDIANA position at Briljent?
Description
Briljent is seeking an Audit Case Disposition Specialist to join our team! The Audit Case Disposition Specialist has multi-functional responsibilities with the Case Disposition team and the Analytics team for the Medicaid Fraud Waste and Abuse Detection Services project.
Work from Home position - Indiana resident required
Essential Duties:
- Monitor the progress of audit cases within the case management system and ensure that appropriate actions are taken
- Assists medical reviewers as required and conducts various Medicaid audits independently
- Work collaboratively with members of the client Program Integrity Team to determine the status and final disposition of each case
- Review medical records for accuracy, completeness, and consistency with state and federal rules and regulations including professional coding standards
- Research Indiana Medicaid rules and regulations and update repository with new bulletins, policies, and procedures
- Prepares the draft and final audit findings reports for medical reviews and audits conducted and submitted for Lead approval.
- Prepare audit letters and other notifications for providers and ensure that the client has approved all letters before they are sent out
- Respond to provider inquiries regarding the status of an r audit and ensure prompt and provider-friendly approach
- Assist with the coordination of the appeals process
- Assist with notifications, tracking, collection, and reporting of overpayment recoveries
- Work with team members to develop appropriate educational materials for providers
- Assist in developing policies, procedures, processes, and workflows to support the Audit Case Disposition Process
- Provide input into the configuration, testing, implementation, and ongoing operations of the case management system
- Coordinate activities and case dispositions with other functional teams as needed
- Recognize situations requiring urgent attention and manages situation through to resolution via escalation and timely communication
Requirements
- Excellent oral and written communication skills
- Proven knowledge of MS Excel
- Strong initiative and ability to work well under pressure with minimal direction
- Ability to plan and prioritize work efficiently
- Ability to work within well-defined processes
- Ability to collaborate within a team-oriented environment
- Excellent time management skills
- Able to regularly take mailings to local UPS location
Education and Experience:
- Bachelor's Degree preferred
- 3-5 years of experience in customer service, administrative support and/or data entry within the healthcare, insurance, or government sector
- Medical coding experience with one or more of the following credentials: CPC, CPC-C, COC, RHIT, or CPMA.
- Experience working collaboratively with healthcare providers is strongly preferred
- Some knowledge or experience with healthcare claims data and healthcare fraud
Other Information:
- Briljent is committed to a diversified workforce, creating an inclusive workplace for all employees.
- Must be eligible to work in the United States. No sponsorships are available currently.
Physical Requirements & Environmental Conditions:
These physical demands must be met by an employee to successfully perform the essential functions of this job. Employee is regularly required to communicate, remain in a stationary position, and utilize technology tools such as a laptop computer for extended periods of time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes diversity and inclusion are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.
